The potential of Healthcare.gov

The Department of Health and Human Services continues its rapid
roll-out of new data initiatives that bring ordinary Americans
digitally into the heart of the health care system. Today, HHS
announced the latest in these open government projects, which
collectively provide excellent examples of the goals behind opening up
data–not data for data’s sake, but data as a tool people can use to
get more involved in policy, have an impact on civic life, and
hopefully make their own lives better along the way.

Healthcare.gov grows out of a
requirement passed as part of the recently-passed health bill, the
Patient Protection and Affordable Care Act. The site features a
searchable compendium of health care insurance options, public and
private, ranging from any applicable private plans to children’s
coverage (CHIP), Medicare, Medicaid, and high-risk pools. So far as
HHS knows, this is the first web site combining public and private
options from across the country.

Those of us who have compared insurance plans know that each company
combines options in different ways, defines terms differently, and
makes it as hard as possible overall to compare their plan to any
other. We get the impression that the problems of data filtering and
curation would be easier to solved for the Search for
Extra-Terrestrial Intelligence or sequencing the human genome than for
choosing the best insurance plan.

Healthcare.gov takes some big steps toward clarity in the area of
health insurance. I had a chance to talk to Todd Park, the CTO of HHS,
about the new site, and based this blog partly on his description and
partly on a couple sample runs.

Currently, you visit the site and answer a short series of questions.
Based on your answers, it then searches its inventory of potential
coverage choices to produce a customized menu of options that may be
right for you. The site supports over three billion potential
personal scenarios (potential combinations of answers to the site’s
questions) in all.

I tried walking through the site with two typical scenarios. In the
first I came in as a typical graduating college student with no job. I
answered six questions and found seven options, ranging from Medicaid
to the high-risk pool and signing on with my parents’ plan.

In the second scenario, I answered six questions as the self-employed
head of a family with a middle-class professional income. I turned up
a few dozen plans from eleven vendors along with state-specific
information. When I clicked on a private vendor, I saw a list of their
plans with three links to key sets of information on each plan:

View Plan Benefits

Check For Your Doctor

View Drug Coverage

Each link took me to the health care provider’s site, so
Healthcare.gov served here as a referral service without helping me
compare plans. That’s going to improve. Starting in October,
HealthCare.gov will also include price estimates for private insurance
plans, along with more detailed information on deductibles,
coinsurance, and copayments. This will cut through a lot of the
complexity caused by the variation I mentioned before in company
plans, and enable consumers to make head-to-head cost comparisons
between plans.

Update, 2:00 PM: Another valuable feature to be added to this site is
a calculation of how much of the premiums–customer payments–into
health care insurance actually goes to health care as opposed to
overhead.

The private insurance plan data on HealthCare.gov comes from a
market-wide data request HHS issued to all insurance carriers. Over
one thousand insurance carriers, offering many thousands
of plans, are represented on the site.

Other features of Healthcare.gov include:

Consumers’ rights under the health care bill–for instance, how
COBRA works, how spouses can enroll under partners’ plans and
children under 26 can enroll under parents’ plans

I actually think the search function, if it produces useful, practical
results, will do more to explain the health care law than any text.
Because most people (myself included) didn’t read the bill, they had
no way to tell what it meant for them and their families. Hence the
widespread distaste for a bill that makes life materially better for
many of the people who carp about it.

Healthcare.gov will (for the first time on any website) let people
evaluate different options, both private and public, and find out some
of what they actually get from Patient Protection and Affordable Care
Act. (I am not, by the way, embracing this bill as the best feasible
approach to health care. I’m just saying that it has tangible effects
on people’s access to health care, making available new options that
were closed off to them before.)

Another bit of unfinished business is the format of Healthcare.gov’s
data, which is available through a search but not yet downloadable
through an API. That feature is on the HHS to-do list. Some other data
from HHS–including the huge,
recently released set–will be available in December through a
“health indicators clearinghouse.”

The American Recovery and Reinvestment Act, and now the landmark
health care bill, have brought burdens as well as opportunities to
health care providers and the public. HHS has shown a sensitivity to
the needs of those affected by the bills, and a responsibility to make
it easier for them to get its benefits. That responsibility drove its
creation of the CONNECT project, which I
discussed in a recent interview,
and the derivative NHIN Direct
project, the topic of another interview.
while those reach out to health care providers, the new data sites
serve everyone.

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What if I don’t want the government to do things for me? Is it so hard to understand I don’t want “burdens as well as opportunities”?

“We’re from the government and we’re here to help.” Right.

When you show you can manage an oil spill, I’ll consider letting you muck with health care.

wyrmmage

David, I completely agree. My thoughts while reading this article were pretty much “But what if I don’t want the government coming up with lists of private healthcare businesses?”

The possibility for abuse here is mind-boggling. To use a tech metaphor: this is going to be the app-store, but with private health care businesses instead of apps. It’ll be a huge mess, because either the government will only let select private health care businesses be on their web site, which could make the site function well, but will be unfair to those excluded from the site, or everyone who offers healthcare services will be on the site, and the lists will be so overflowing that no one will use them.

Neven

David:

“What if I don’t want the government to do things for me? Is it so hard to understand I don’t want “burdens as well as opportunities”?”

That one is easy – don’t use the above website.

“When you show you can manage an oil spill, I’ll consider letting you muck with health care.”

So you’re saying clearly the solution is for healthcare to be 100% privately run, managed, and regulated, since that has worked out great in the oil industry?

Wyrmmage:

“…or everyone who offers healthcare services will be on the site, and the lists will be so overflowing that no one will use them.”

Oh, you mean the way every provider search already works today? How would you like to see it work?

Ian

A couple of suggestions for those who do not like the way healthcare.gov is built:

A) Provide feedback using the “was this helpful” buttons on their site. The introduction video solicits criticism to make the site more useful.

B) Do not use the site (as Neven said). Continue to find health insurance, data about healthcare legislation, and provider quality comparisons with whatever tools you were using before. The presence of this site does not detract from existing sources of information.

Faisal Qureshi

The operative word here in the title is “potential”. It’s 1.0 website and Ian’s comment is spot on, either help or get out of the way.

The site has useful information for millions that actually need it. For decades, the free market failed to respond to these needs.

Steve Labinski

I’m skeptical of the benefits as well.

If this site is to be the resource guide for all things related to health care, why won’t this website ultimately meet the same fate in usefulness as Yahoo’s original Directory “search engine” ?

Sean Doyle

Re: Steve Labinski

I half agree – wouldn’t it be great if it had the same fate as Yahoo’s original directory? But that directory was good scaffolding for things that came later. If part of the problem here isn’t information but how to intelligently package information… why not let a number of the actors currently in the field take their best shot? As long as it’s not coercive or restricts others from packaging the information it’s potentially an artifact to learn from.

Tim O'Reilly

David -

If you’re so fond of the private sector handling things, why do you think it’s the government’s responsibility to “manage an oil spill.” Just as you expect the government to step in when the private sector (i.e. BP) isn’t doing the job of protecting the public interest, you should expect them to help out here too. Our health insurance system is as big a mess, with as big an impact on many people, as the oil spill. Please explain the difference.

Joe McCarthy

I’m not a supporter of the Patient Protection and Affordable Care Act. I see it as yet another example of what Annie Leonard, producer of “The Story of Stuff” and “The Story of Cap and Trade”, refers to “marginally better than terrible”.

Rather than debate the merits of the legislation, I’ll simply note here that I don’t see how any bill that is over 2000 pages can be consistent with the idea of transparency in government.

That said, I’m encouraged by what I’ve heard and read about the HealthCare.gov site, especially Andy’s observations about its use for helping make the health care reform bill more intelligible. I’m also encouraged by the provisions for feedback within the site.

However, all the reports I’ve read so far have been about how hypothetical people might use the site, and the potential utility of the information they might find. I realize this is only the first day it has been in use, but I hope Todd Park’s plans include extensive evaluation of whether and how the site helps real people find real solutions to real health care problems … and the cases for which the site – and the bill – falls short of its goals.

Tony

I don’t care what the right wingers say on this, having this kind of price transparency between insurance companies and the ability to compare plans is great, and it’s ultimately going to drive down prices. If people are looking for a free market way to move towards universal coverage, this is the way to do it. This kind of system’s already been shown to work in germany, switzerland, and massachusetts by mitt romney. Anyone pretending this is some federal plot to take over the healthcare industry has been misinformed.

Av

Healthcare.gov will evolve into the portal for millions of families and small businesses purchasing coverage through the health insurance exchanges starting in 2014, under the Affordable Care Act. Folks who earn too much to qualify for Medicaid (up to 400 percent of the federal poverty level) will receive tax credits on a sliding scale based on income to help them purchase private insurance. Certain small businesses will get tax credits for providing coverage to their workers. All these people will purchase their health plans through state-run exchanges with portals that resemble healthcare.gov. Exchanges will present head-to-head service and price comparisons for a set of standardized health plans with different levels of premiums and richness of benefits.

This will make it easier to compare plans from different companies and keep insurers from introducing gratuitous and mind-numbing complexity into their offerings to obscure important differences and take advantage of consumers. This portal and the exchanges will end that game for good. This kind of health plan standardization has worked flawlessly since 1989 in the market for Medicare supplemental coverage, and private insurers have made a ton of money selling that without ripping off the public.

The new law isn’t a takeover, it’s just a supervised marketplace that’s fair to consumers for a change. Why is that so terrible?

Brian Ahier

Good post Andy. I’ll leave the editorial comments to others, but I will say that it’s interesting how the launch of this website has sparked renewed conversation on the health insurance exchange topic.
There is also video of the announcement by Secretary Sebelius and HHS CIO Todd Park (see http://ahier.net/video-healthcaregov-launched )

Joe McCarthy

For an early and rather extensive report about a person with a real health care insurance need using the site to find a solution, I highly recommend web designer and extraordinary patient advocate ePatientDave’s evaluation of HealthCare.gov. He finds the site easy to navigate and already yields useful info, although the capability to comparison shop – due in October – will likely make a big difference in his utility assessment.

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